The purpose of this project was to bring graduate Masters Entry Nursing (MEPN) students together with students from Veterinary Medicine (VetMed) in an interprofessional (IP) case-based learning experience and to evaluate the experience.
Rationale/Background
The Institute of Medicine (IOM) and the American Association of Colleges of Nursing (AACN) recommend building competencies in IP collaborative education (IPE) and practice (IPP). An IPE approach provides the potential for beneficial outcomes including improved clinical knowledge, interprofessional role development, communication and collaboration within teams in the clinical setting. There are limited reports in the literature which describe the steps needed to develop and implement IPE experiences for graduate students in the health care professions. However, there is some consensus that readiness for learning, the inclusion of interactive learning elements, and matching student learners within the context of their professional development could be a key to success.
In order to close some of the gaps in knowledge about specific IPE course development, a full day pilot seminar was developed for a group of MEPN and VetMed students by faculty in the graduate nursing and veterinary medicine programs at a large West Coast public university in the United States. The four faculty members who developed the seminar were part of a nine-month Interprofessional Teaching Scholars Program (ITSP). One of the deliverables for the fellowship was the creation of a final project. The IPE seminar was chosen with the premise that all represented disciplines should be involved from the onset in the development of IPE teaching and learning sessions which include their discipline.
The Project
Faculty worked together to create an all-day (eight hour) case-based problem-learning seminar about an elderly man with mild dementia, George Palo (age 90) and his Golden Retriever, Max (age 13). The seminar was divided into four subsections and implemented on Saturday, May 13, 2017. Topics included: 1) Pain assessment and management in non-verbal mammals; 2) Cross species infections; 3) Therapeutic benefits of the human/animal bond; and 4) Grief and loss/Death and dying.
Twenty-four MEPN and 13 VetMed students followed the fictitious case of “George and Max” throughout the day. The scenario began with both entering the emergency department with gastric distress, lethargy and vomiting which was a result of a cross-species infection. A coherent history was unattainable from George. As the scenario unfolded, it became apparent that Max had a terminal condition and George needed to decide about whether or not to prolong Max's life. Each of the four sessions began with a mini-lecture on the topic. After the lecture, students were separated into groups of eight for the small group work facilitated by two faculty members (one from each school). The groups reconvened into the large group to report their work. There was an hour break for a catered lunch and at the end of the seminar, MEPN students had the option to take a tour of the animal hospital.
The IPE faculty encountered challenges during the development phase which included administrative resistance for implementing the seminar. The resistance stemmed from the structural and logistical differences in curricula for each school, concern about violation of the Carnegie Rules, the conundrum of how to provide students units/credit for the session, a 20 mile geographic separation between the two different schools, and resources such as funding, materials and faculty time.
A step by step script, objectives and a timeline was developed. Each faculty representative was responsible for recruiting faculty facilitators and students from their respective schools and developing the mechanics for providing course credit for students. Course materials were placed on a mutually accessible student management system in advance of the program. Faculty facilitators were provided the script, objectives, and teaching guidelines a week in advance of the session.
Student and faculty evaluations of the program were obtained which included reflective writing about the session. Twenty-eight students and six faculty facilitators completed the evaluations.
Outcomes
All 24 MEPN students participated as part of a collaborative practice course. It was difficult attracting VetMed students for the Saturday session. Saturday was originally chosen in order to avoid conflicts with other courses. Also, the VetMed students were varied in their educational journey, ranging from undergraduate to postgraduate.
Both students and faculty expressed satisfaction with the session and provided substantive descriptions about what worked and where improvements might be made. Students verified the benefit of taking an interprofessional approach to clinical scenarios. For example, one MEPN student stated, “Stepping into their (VetMed) shoes and looking at the case through their lens made me look at the case from a much broader perspective”. Other students reported acquiring new clinical knowledge such as how to assess non-verbal patients, how to approach grief and loss in a geriatric patient and how to assess dehydration which was similar in both human and animal cases.
Faculty facilitators reported that the small group discussions with a mix of students were beneficial to learning. They appreciated the scripted guidelines. They also suggested pre-session training for facilitators, creating better matching for student learners between disciplines and avoiding Saturdays.
Conclusion
Creating meaningful IPE experiences can be labor intensive and time consuming, but also rewarding for students and faculty. The pathway to success lies in the ability to overcome structural and resource challenges, to obtain administrative support, to develop an organized program with clear objectives, guidelines and a timeline at the onset with the IP faculty team, to provide adequate faculty development and to match student learners for a maximal learning experience.
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